As the Pharmacy Benefit Managers (PBMs) prepare for the end-of-year “housekeeping”, pharmacies should be aware of the PBM audit trends and arm themselves with information necessary to preempt—and strategies to outright avoid—falling victim... Read More
Antitrust Review and Compliance | Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Biotech Companies | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Uncategorized

In the course of pharmacy audits, PBMs are increasingly requesting from pharmacies copies of Drug Supply Chain Security Act (“DSCSA”) track and trace documents, commonly known as “T3” documentation. The T3, which consists of the Transaction... Read More
Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Home Infusion Providers | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Frier Levitt has been closely monitoring Express Scripts’ (“ESI”) administration of TRICARE, the health care program for uniformed service members and their families. Earlier this year the Defense Health Agency (“DHA”) awarded ESI a... Read More
Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Uncategorized

As a result of the increased marketing by payors of over-the-counter (“OTC”) cards to plan members, pharmacists are being placed in jeopardy by patients who do not know, or appreciate, the legal complexities around proper use of these cards. The... Read More
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As we begin to enter the holiday season, pharmacies need to be cognizant that not everyone is eager to dive into the holiday spirit. Indeed, for pharmacy benefit managers (“PBMs”), the holiday season is merely the starting point of year-end... Read More
Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Home Infusion Providers | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

On September 23, 2022, the Fourth Circuit issued a per curiam opinion upholding the dismissal of a 2014 qui tam suit against Forest Laboratories, LLC while vacating both the district court and subsequent Fourth Circuit panel opinions. Although the... Read More
Articles | Federal and State Fraud and Abuse Counseling | Manufacturers | Maximum Allowable Cost Pricing & Appeals | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers | Pharmaceutical Wholesalers | White Collar Criminal Defense & Government Investigations

The deadline for Plan Sponsors to submit considerable and illusive drug spend data required under the Consolidated Appropriations Act (“CAA”) is December 27, 2022. The CAA requires group health plans and health insurers to submit prescription... Read More
Articles | Plan Sponsor PBM Contract Services

The recent increase in proposed State Legislature across the U.S. in an effort to regulate Pharmacy Benefit Managers (“PBMs”) demonstrates rising scrutiny by the government into the abusive conduct of PBMs and the impact it has on American... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Plan Sponsor PBM Contract Services

Independent pharmacies and providers must be vigilant based on a recent uptick in network terminations (many of which are not justified) by pharmacy benefit managers (“PBMs”) throughout the country. The fact that PBMs will often issue... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Long-Term Care Pharmacies | Payor Network Access and Defense of Network Terminations | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Since being established in May 2022, New York’s Pharmacy Benefits Bureau (“Bureau”) has requested input from the public on several occasions regarding New York’s laws governing Pharmacy Benefit Managers (PBMs). The Bureau’s most recent... Read More
Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Life Sciences | Maximum Allowable Cost Pricing & Appeals | Pharmacy Law